|Year : 2017 | Volume
| Issue : 3 | Page : 89-95
Healers and healing practices of mental illness in India: The role of proposed eclectic healing model
Ramakrishna Biswal1, Chittaranjan Subudhi2, Sanjay Kumar Acharya3
1 Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha, India
2 Department of Humanities and Social Sciences, National Institute of Technology, Rourkela, Odisha; Department of Social Work, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
3 Department of Psychiatry, Ispat General Hospital, Rourkela, Odisha, India
|Date of Submission||10-Jul-2017|
|Date of Acceptance||04-Sep-2017|
|Date of Web Publication||6-Oct-2017|
Department of Social Work, Central University of Tamil Nadu, Thiruvarur - 610 005, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Much of the debate on mental illness has centered on cultural difference as a way of dealing with the health-care practices. The varieties of health-care practices induce medical pluralism. In India, this medical pluralism can be observed through the assortments of healers and healing practices. The cultural determinism of any health-care practice comprises traditional or indigenous and modern health-care practices which are embedded in the health culture of country's healing system. This medical pluralism not only provides different forms of healing practices but also addresses different ways of perceiving, explaining, and managing the illness. Nevertheless, consultation with a particular healer is governed by a set of sociocultural beliefs, background of the patients along with the family members which has also been followed through the accessibility and availability of such healers. By exploring the dominance of different types of healers and their healing practices toward mental illness from the preexisting research in India, the present paper tries to show how health-care system in mental illness also represents the kaleidoscope of medical pluralism. Furthermore, the authors have proposed a new model the “eclectic healing model” of mental illness.
Keywords: Eclectic healing model, healer, health care, medical pluralism, mental illness
|How to cite this article:|
Biswal R, Subudhi C, Acharya SK. Healers and healing practices of mental illness in India: The role of proposed eclectic healing model. J Health Res Rev 2017;4:89-95
|How to cite this URL:|
Biswal R, Subudhi C, Acharya SK. Healers and healing practices of mental illness in India: The role of proposed eclectic healing model. J Health Res Rev [serial online] 2017 [cited 2019 Aug 18];4:89-95. Available from: http://www.jhrr.org/text.asp?2017/4/3/89/216066
| Introduction|| |
Mental illnesses are health conditions involving changes in thinking, emotion, or behavior (or amalgamation of three) which is associated with distress and/or problems functioning in social, work, family activities or daily life. Two important but opposite models of mental illness, i.e., the medical model and the nonmedical model regarding the etiology and explanation of mental illness and healing practices exist in most of the societies in the world as well as in India. While the medical model adheres to an objective and scientific analysis of mental illness, the nonmedical model is popular for its subjectivity and often offers highly overlapping explanations with regard to diagnosis and healing. Both of the explanatory models (the medical model and the nonmedical model) of mental illness emphasize that healing practices are based on people's beliefs. These beliefs include the causation of illness, norms for governing choice and evaluation of treatment, and socially legitimatized statuses, roles, power relationships, interaction settings, and institutions. Belief is a powerful tool or mechanism that highly affects the health-care system. Considering a country like India, blind beliefs and beliefs in the supernatural etiology of mental illness are highly prevalent among major chunk of the population, especially in rural and tribal areas comprising lower-caste and lower-class population. These irrational etiological beliefs center around spirit possession, witchcraft, breaking of religious taboos, divine retribution, capture of the soul by spirit, and many more. Due to the seemingly explanatory power of the nonmedical model of mental illness, traditional healers are sought after and become the first choice to be consulted by the family members of persons with mental illness in both rural and urban areas.
In the 21st century, traditional healers and their healing practices constitute a vital component in the Indian health-care system. More than two-thirds of people with mental illness and their family members have a strong belief in the supernatural causation of mental illness, and this belief forces them to consult traditional healers before resorting to modern health care. Beliefs and help-seeking behaviors are highly correlated with each other and are greatly influenced by the culture. According to Hunter and Whitten, human beliefs are “thoughts that are based on the uncritical acceptance of the inherent truth or correctness of the cognitive categories of one's culture.” All the cultures have a system of illness beliefs to explain what causes illness, how it can be cured, how and from whom to seek help, how the victim responds to a specific therapy, and who should be involved in this process. Hence, cultural beliefs highly influence health-related behaviors and are also reflected in a society's health-care system. Cultural beliefs and practices affect nearly all aspects of mental illness, especially including assessment and diagnosis, illness behavior, and help-seeking and mutual expectations of interaction between patients and practitioners.
| Cultural Construction and Health-Care System|| |
Every society is profoundly ruled by its own way of life known as culture which is followed by every individual belonging to that particular culture. Glick (1967) hypothesized that “knowing a culture's chief sources of power (social, political, mythological, religious, technological, etc.,) allows one to predict its beliefs about the cause of illness and how to treat illness.” Hence, any type of illnesses including mental illnesses is not free from the periphery of cultural construction. The beliefs and the help-seeking behaviors are inseparable domains of the culture. The culture and help-seeking behavior are often perceived to have multiple interdependent layers in understanding and assessing mental illness along with diagnosis, help-seeking and its management. Every culture has developed its own supporting system (e.g., knowledge, beliefs, techniques, attitudes, customs, rituals, and symbols) for any kind of disease or illness. This vast complex system and all of the other items we might think to add to the list constitutes a “health-care system.” That is why the health-care system properly embraces the totality of health knowledge, beliefs, skills, and practices of the members of every group. The eminent American psychiatrist, Aruther Kleinman, has given a theoretical framework of the local health-care system comprising three broad categories, i.e., popular sector, professional sector, and folk sector. The model remains almost valid beyond cultural boundaries while the contents inside each sector vary with the social, cultural, and environmental circumstances. This model is highly suitable to the societies such as posttraditional, classical, or folk-healing traditions.
Each sphere of the model is overlapping with the others. However, the sphere of the popular sector is the largest among the three. The popular sector is the home of lay, nonprofessional, and nonspecialist people which contains several levels: individual, family, social network, community beliefs, and activities. Choice of treatment starts from this sector following consultation with neighbors, relatives, old and experienced people from community, and friend circles. Based on the decision, the patient enters either professional or folk sector for receiving treatment. Subsequently, to every healing, the patient returns to the popular sector for evaluation of the condition for deciding the next course of action.
The professional sector is the second sector of the local health-care system that follows organized healing practices. It prescribes modern scientific medicine. Even countries like China and India have their own indigenous medical system, i.e., traditional Chinese medicine and Ayurveda, respectively, which come under the professional sector. The last one is the folk sector which is also known as the nonprofessional and nonbureaucratic sector. It is considered as a mixture of both the professional and the popular sector. This sector focuses the shamanism and ritual curing, etc., That is why the healers under folk sector are considered as nonprofessional healers. Every sector possesses its own explanatory system, social roles, interaction settings, and institutions. In the health-care system, the folk sector and the popular sector are highly dominant in those societies where less people are available from the professional sector. The mental health-care system in the Indian context is elaborated next.
| Healing Practices for Mental Illness in Indian|| |
India is a culturally diverse country where it is believed that, in every 25 mi, we come in contact with people from a diverse culture. The country is also associated with more spiritual traditions from primeval times and is known as a sea of all religion and culture. This cultural disparity affects the Indian health-care system. A variety and diversity of modern and traditional healers are found in each corner throughout the country to alleviate mental health problems., This medical pluralism not only provides health-care facilities but also explicates the illness in diverse ways., Thus, pluralistic approach to health care is used for all kinds of illness, it may be physical or mental. Even people are consulting multiple healers to get relief from the illness to an extent that a failure or unsatisfied outcome from one healer forces them to consult another healer. Some motivational factors that determine the choices for healing practices, i.e.: (i) strong belief of the decision-maker (may be family members, relatives, peer groups, and community people) in faith healing, (ii) easy approachability, (iii) social stigma associated with psychiatric consultation, (iv) the belief about the causation of mental illness, (v) lack of awareness among common public, and (vii) deficiency in existing mental health services.,,,,,,
In case of mental illness, folk healers and religious healers are the predominant choice for the majority of the population because 75% of the patients take recourse to folk or religious healing before resorting to psychiatric services., Other studies show that the needs of about 60% of patients were met by the folk practitioners and home remedies. Another 20% depended on indigenous medical practitioners and rest 20% of patients turned to medical care from the qualified practitioners. With respect to the place of healing, Campion and Bhugra found that 25% of the patients consulted healers in their own homes, 25% consulted them at temple site, and the rest went for consultation in the traditional healers' house.
Particularly, in Indian villages, several kinds of healers are in practice to treat mental illness. Weiss et al. found four types of healers: practitioners of Ayurveda, folk healers, healers in temples, and allopathic healers (psychiatry). Indian medical pluralism has been broadly divided into two sectors – traditional and modern health-care sector. The traditional health-care sector is again divided into three legends – folk sector, religious sector, and classical sector. All the health-care services taken together form a model for mental health care called as “eclectic healing model (EHM) for people with mental illness.” Four major health-care services come under this model, i.e., folk sector, religious sector, classical sector, and modern medical sector [Figure 1]. Each health-care sector has its unique way of elucidating the illness and following a certain method of healing.
|Figure 1: Eclectic healing model for people with mental illness in India|
Click here to view
The proposed EHM model is an elaborate, extended, and improved model of healing in comparison to Kleinman's model where the interrelated and interdepended process of healing is incorporated. For people with mental illness, the decision-makers for treatment often constitute the family members, peer groups, relatives, and people in the community. They influence the person with mental illness persuading him/her to adhere to either form of the healing such as religious, folk, classical or modern medical based on either own or either success experiences. However, none of the systems is self-sufficient to bring a desired success in treating mental illness, rather each system contributes to the healing process and each system is interrelated to the other system. The patient follows each system of healing either successively or simultaneously. Since the treatment of mental illness is time-consuming, success comes in between or takes a long time with all system working as a tandem.
Hence, the proposed model suggests a system of healing practices. Further, the complexity increases with the intervention of various decision-making factors and agencies. Their involvement with the patient and healing practices strengthen EHM. Therefore, in a country like India, EHM is a reality and highly adopted healing method. Next sections have described the contribution of each of the healing practice sector.
| Folk And Religious Sector|| |
The folk sector and the religious sector are considered as the primeval health-care service providers in India. In the religious sector, the authors here specifically focused the temple healing practices in the country. Although Kleinman  has categorized the religious practices under the folk sector in his local health-care theory, in the Indian context, religion has a significant impact on society and religious places are highly accepted by all sections of the population. Religious places are the established institutions in Indian society and have a historical significance for providing healing practices. Although both folk and religious sectors follow supernatural etiology, the healing processes vary from one another. In both the sectors, the chief causation of mental illness is due to the breach of taboo (misdeed) either by the victim or by his ancestor in their present life or previous incarnation, personal sin, evil intent, angry deities, soul loss, intrusion by various elements, sorcery, etc. A host of studies has found that some uncommon blind beliefs lead to mental illness. A prevalent belief among rural villagers is that if a person had killed a cow during his past life, he would suffer from mental illness in the present life. Almost 35% of people believed that vaginal or semen secretion is one of the major causes of mental illness. Study by Weiss et al. found that there are distinctive external causes of mental illness as “Brahmins turn to spirits after they die, and some bad people may call upon their spirits to hurt other people (enemies) causing mental illness.” In both these sectors, the etiology is often overlapping with one another.
The healing process in religious places is based on religious prayers, ritual activities, and the process is almost same for the all the victims. It is believed among people that the religious prayers and pooja (hawan) would help to reduce the effect of the mental illness., The ritual prayer is accompanied with some practices such as fasting or eating raw fruits and performing prayer for a regular period. These healing practices are performed by the priest of the temple or father of the church or the imam of the mosque. The healers usually follow the same pattern of offering prayers for all patients. This type of religious healing is widely used for managing mental illness and is the first choice among people to cure the mental illness., A majority (46%) believe that offering prayer is the only way to cure mental illness. In a study by Thara et al. reported that interestingly, six patients found an improvement in their condition through religious healing. The factors that contribute to preference for religious healing include such considerations as nearness to home (20%), safety level of the religious places, failure of modern treatment (80%), and influence of family members and friends (66%). Unlike, other forms of the physical disease which takes relatively less time, mental illnesses take more time to cure. A lack of understanding and knowledge about mental illness among the public helps them form the opinion that modern treatment is a failure system for mental illness.
In the folk sector, the healers (practitioners) belong to heterogeneous groups or religions. They are labeled as folk doctors, witch doctors, anti-witches, or shamans; the accepted local nomenclatures are gunia, tantric, baba, ojha, fakir, sadhu, and so on. The nomenclatures are based on their training, functioning, ceremonies, and so on. In general, it is a family profession or business in which the successors learn this art from their ancestors and continue the profession. They usually belong to poor or lower middle-class families and have no professional qualifications. Their healing processes employ a mixture of modern and traditional medicines along with some religious forms to cure the illness. The process of healing differs from one patient to another according the presentation of the problem by the patient or his family members. They examine hands, head, eyes, hairs, or do some numerical calculations from the patient's name and then provide treatment. They use different healing techniques such as chanting spells, poking the patients with pins, or beating and flogging, slapping, tying in ropes and chains, scalding, and even blistering by a red hot iron. Some folk healers also give tabiz (amulet), casting of charms, or bala (ring) to wear which, they believe, would protect the patient from evil forces and give handmade tablets or powders prepared from special kind of herbs, oils, or unknown chemicals to reduce the intensity of mental illness., People with mental illness have attended all types of folk healers to get relief from their illness. A significant proportion of the patients consult folk healers as a first choice for their treatment. Studies reveal that 45% of psychiatric patients have sought about 1–15 sessions with folk healers in South India and nearly about 40% of patients consult faith healers in Northern India before resorting to psychiatric care.,, The reliance on the folk healers may be partly attributed to the absence of modern mental health-care professionals; second, lack of awareness among the public regarding the availability of medical care and treatment for mental illness. Third, they waste a significant amount of time in the process leading to a failure in early detection and treatment of the disease.
| Classical Sector|| |
Ayurveda, the science of life, was developed in the 6th century BC and was popularized between 3rd and 8th centuries AD. It is the indigenous and traditional health-care sector in India. Ayurveda has borrowed from the ancient enriched classical text such as Charaka Samhita, Susruta Samhita, and Astangasangraha. Ayurveda is based on the humoral concept of disease etiology. A healthy person possesses a balance of three body humors, i.e., wind, bile, and phlegm (vata, pitta, and kapha) and three psychic factors, i.e. sattva (light), rajas (activity), tamas (darkness) and five elements (Pancha-mahabhutas), i.e., water, air, fire, earth, and sky. The balance of these three humors (tri-dosa) and three psychic factors (tri-guna) keeps our mind, soul, and sense organs healthy. For example, in tri-dosa, vata is responsible for movement, pitta is responsible for metabolism, and kapha is responsible for binding. Tri-guna (Sattva, Rajas, and Tamas) are the integral components of mind.,, Any type of diseases or illness occurs due to the imbalance of these humors or psychic factors.
In Ayurveda, severe mental illness is known as Unmada. Charaka has described four causative factors for Unmada: (a) diet (incompatible, vitiated, and unclean food), (b) disrespect to gods, elders, and teachers, (c) mental shock due to emotions such as excessive fear or joy, and (d) faulty bodily activity (inappropriate thinking or understanding which leads to improper action; unfavorable personal, social, or environment conditions)., Other causative factors are sexual overindulgence; stress and vulnerability during battle; sexual intercourse during full moon or the new moon; effects of ancestral spirit; violation of social taboos; past life activities (violated vows, promises, or deeds); and possession of spirit (not the evil spirit but certain types of gods like gandharva, yaksa, etc.).,, Three types of Unmada are possible due to humor imbalances, i.e., vatounmada, pittounmada, and kaphounmada. Apart from these three types of Unmada, classical text has classified Unmada into other different categories, i.e., apasmara (epilepsy), avasada (depression), manasavikara (neurosis), chittodvega (anxiety), and unmada (psychosis) etc.
The healing of Unmada is broadly divided into three categories.Daiva Vyapashraya suggests ritual practices, sacrifice, spiritual healing, and recitation of sacred verses (incantation) to cure Unmada. These activities are recommended in Unmada caused by the extraneous factors or spirits. Yukti Vyapashraya is the practice of using ghee/oil, milk, decoctions, herbal medicines, and certain food restrictions to cure Unmada. Herbal medicines are Ashwagandha (Withania somnifera), Kushta (Saussurea lappa), Tagara (Nymphoides macrospermum), Brahmi (Centella asiatica), Sarpagandha (Rauwolfia serpentina), Vacha (Acorus calamus), Bigchanda, Thankumi, Antamul, and Jatamansi (Nardostachys jatamansi). Satvavajaya deals with psychotherapy, i.e., spiritual knowledge, moral boosting, etc., which help to cure Unmada. This form of psychotherapy will help the mind to restrain from the desire for unwholesome objects.
Kleinman has put Ayurveda and allopathic under one purview of local health-care sector, i.e., professional sector. However, the disease etiology and the healing process of Ayurveda vary widely from that of allopathic. Ayurveda considers a biopsychosocial approach along with supernatural etiology in formulating causative factors in mental illness whereas the allopathic does not recognize the same kind of etiology. For the above-mentioned reasons, the author has categorized Ayurveda in the classical sector.
| Modern Medical Sector|| |
Modern medical sector mostly emphasized on allopath (psychiatry) and clinical psychology. The role of the psychiatrist is to prescribe medicines along with clinical psychologist providing the therapeutic treatment. Allopath states that the condition of mental illness is a failure or problem in organic or the psychological realm. In the same time, the psychologists view this condition of disturbances of the individual's behavioral and psychological functioning as an outcome of interaction of biological, cognitive, developmental, and sociocultural factors. Mental illness is illness characterized by the presence of mental pathology that is disturbance of mental functioning analogous to disturbance in bodily functioning. Therefore, there is no supernatural power or forces or evil spirit which constitutes the etiology of mental illness. Since mental illness is illness just like other physical illness, it requires specific treatment. Hence, psychiatrists are generally prescribing drugs with an aim to change the functioning of the brain. In allopathic domain, three therapies have been prescribed: (i) drug therapy, (ii) psychosurgery, and (iii) brain stimulation therapy (electroconvulsive therapy). When drug therapy and psychosurgery would not help full recovery, then electroconvulsive therapy may prescribe. In the domain of psychology, different kinds of psychotherapies, for example, cognitive behavioral therapy, psychoanalytic therapy, etc., are prescribed by the trained psychotherapists which will help the individual with mental illness to change certain behaviors, thoughts, or emotions. A lot of therapies are available but prescribed according to the needs of the client.
| Conclusion|| |
The four health-care sectors discussed above have their own standpoints regarding the etiology of mental illness and healing practices. Each sector is unique in its assumptions, and the jumble of all sectors is labeled as an EHM for people with mental illness. The current EHM for people with mental illness is not opposing the theoretical model of local health-care system given by Kleinman. However, in case of Indian scenario and especially in the field of mental illness, the proposed model is better fit. Although in certain cases, the some sectors are overlapping to each other, they (each sector) have their own set of beliefs and healing practices.
All the sectors are followed by people simultaneously to get relief from mental illness. It is reported that nearly 66% of patients consult multiple healing points. However, the choice of preferring one sector over the other depends on the beliefs of the patient and their family members. Due to the native and cultural construction of explanations relating to mental illness, the folk sector and the religious sector emerge as the first choice among the family members of the mentally ill for purposes of consultation and treatment. Although the modern health-care sector provides the most scientific and most dominant framework for dealing with mental illness, regrettably, the resources available in rural and tribal areas in India are very limited in comparison to those in urban locations. The rural area inhabits majority of the Indian population, and because of limited to access to psychiatric services, most of the people fall back upon traditional and faith healers. Still a long way to go to understand the need and signifince of modern psychiatric services and treatment for mental illness.
The proposed EHM holds promise for developing mental health-care system in the inaccessible areas and areas lack of basic health-care facilities. Through involving the change agents such as the family members, peer groups, relatives, and community people in the process of treatment, awareness can be created along with an objective evaluation of all four systems. The beliefs of the people on any of the four systems must be taken into consideration and evaluated objectively before beginning the treatment of mental illness.
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